Sexual orientation disparities in physical health: age and gender effects in a population-based study
Tóm tắt
Recent studies have identified substantial health disparities between lesbian, gay, and bisexual (LGB) individuals compared to heterosexuals. However, possible variation in sexual orientation health disparities by age and according to gender remains largely unexplored. To examine physical health disparities between LGB and heterosexual individuals in a general population sample in Sweden, to explore potential age and gender differences in these disparities, and to test potential mechanisms underlying any observed disparities. Between 2008 and 2013, 60,922 individuals (16–84 years of age) responded to nationwide population-based health surveys. In the sample, 430 (0.7 %) individuals self-identified as gay/lesbian and 757 (1.3 %) self-identified as bisexual. Logistic and negative binomial regression analyses were used to explore health disparities based on sexual orientation. Overall, LGB individuals were more likely to report worse self-rated health as well as more physical health symptoms (e.g., pain, insomnia, dermatitis, tinnitus, intestinal problems) and conditions (e.g., diabetes, asthma, high blood pressure) compared to heterosexuals. However, these physical health disparities differed by age. Disparities were largest among adolescents and young adults and generally smallest in older age groups. Health behaviors and elevated reports of exposure to perceived discrimination, victimization, and threats of violence among sexual minorities partially explained the sexual orientation disparities in physical health. Age emerged as an important effect modifier of physical health disparities based on sexual orientation. Gender-specific findings suggest that sexual orientation disparities persist into adulthood for women but are gradually attenuated for older age groups; in contrast, for men, these disparities disappear starting with young adults. These results support a developmental model of minority stress and physical health among LGB individuals.
Tài liệu tham khảo
US Institute of Medicine, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding (2011) Washington. The National Academies Press, USA, DC
Meyer I (2003) Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 129(5):674–697
King M et al (2003) Mental health and quality of life of gay men and lesbians in England and Wales: controlled, cross-sectional study. Br J Psychiatry 183:552–558
Cochran SD, Mays VM, Sullivan JG (2003) Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. J Consult Clin Psychol 71(1):53–61
Wichstrom L, Hegna K (2003) Sexual orientation and suicide attempt: a longitudinal study of the general Norwegian adolescent population. J Abnorm Psychol 112(1):144–151
Lick DJ, Durso LE, Johnson KL (2013) Minority stress and physical health among sexual minorities. Perspectives Psychol Sci 8:521–548
Fredriksen-Goldsen KI et al (2013) Health disparities among lesbian, gay, and bisexual older adults: results from a population-based study. Am J Public Health 103(10):1802–1809
Dilley JA et al (2010) Demonstrating the importance and feasibility of including sexual orientation in public health surveys: health disparities in the Pacific Northwest. Am J Public Health 100(3):460–467
Sandfort TG et al (2006) Sexual orientation and mental and physical health status: findings from a Dutch population survey. Am J Public Health 96(6):1119–1125
Kim HJ, Fredriksen-Goldsen KI (2012) Hispanic lesbians and bisexual women at heightened risk for [corrected] health disparities. Am J Public Health 102(1):e9–e15
Conron KJ, Mimiaga MJ, Landers SJ (2010) A population-based study of sexual orientation identity and gender differences in adult health. Am J Public Health 100(10):1953–1960
Steele LS et al (2009) Women’s sexual orientation and health: results from a Canadian population-based survey. Women Health 49(5):353–367
Meyer IH, Schwartz S, Frost DM (2008) Social patterning of stress and coping: does disadvantaged social statuses confer more stress and fewer coping resources? Soc Sci Med 67(3):368–379
Mays VM, Cochran SD (2001) Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. Am J Public Health 91(11):1869–1876
Balsam KF, Rothblum ED, Beauchaine TP (2005) Victimization over the life span: a comparison of lesbian, gay, bisexual, and heterosexual siblings. J Consult Clin Psychol 73(3):477–487
Whitfield KE et al (2013) Introduction to the second special section on health disparities. Ann Behav Med 45(1):1–2
Gee GC, Walsemann KM, Brondolo E (2012) A life course perspective on how racism may be related to health inequities. Am J Public Health 102(5):967–974
Pearlin LI et al (2005) Stress, health, and the life course: some conceptual perspectives. J Health Soc Behav 46(2):205–219
Pollitt RA, Rose KM, Kaufman JS (2005) Evaluating the evidence for models of life course socioeconomic factors and cardiovascular outcomes: a systematic review. BMC Public Health 5:7
Fredriksen-Goldsen KI, Kim HJ, Barkan SE (2012) Disability among lesbian, gay, and bisexual adults: disparities in prevalence and risk. Am J Public Health 102(1):e16–e21
Fredriksen-Goldsen KI et al (2015) Successful aging among LGBT older adults: physical and mental health-related quality of life by age group. Gerontologist 55(1):154–168
Cochran SD, Mays VM (2007) Physical health complaints among lesbians, gay men, and bisexual and homosexually experienced heterosexual individuals: results from the California Quality of Life Survey. Am J Public Health 97(11):2048–2055
Bränström R, van der Star A (2013) All inclusive public health—what about LGBT populations? Eur J Public Health 23(3):353–354
Gonzales G, Blewett LA (2014) National and state-specific health insurance disparities for adults in same-sex relationships. Am J Public Health 104(2):e95–e104
Ponce NA et al (2010) The effects of unequal access to health insurance for same-sex couples in California. Health Aff (Millwood) 29(8):1539–1548
Sexual Minority Assessment Research Team (SMART), Best Practices for Asking Questions about Sexual Orientation on Surveys, 2009, The Williams Institutet: California, USA
Sell RL, Wells JA, Wypij D (1995) The prevalence of homosexual behavior and attraction in the United States, the United Kingdom and France: results of national population-based samples. Arch Sex Behav 24(3):235–248
DeSalvo KB et al (2006) Mortality prediction with a single general self-rated health question. A meta-analysis. J Gen Intern Med 21(3):267–275
Idler EL, Benyamini Y (1997) Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 38(1):21–37
Swedish National Institute of Public Health, The Risk Drinking Project in Sweden. Alcohol Prevention in Primary Health Care and Occupational Health Care, 2010: Östersund, Sweden
World Health Organisation, Global recommendataion on physical activity for health, 2010: Switzerland
Mood C (2010) Logistic regression: why we cannot do what we think we can do, and what we can do about it. Eur Sociol Rev 26(1):67–82
Thomeer MB (2013) Sexual minority status and self-rated health: the importance of socioeconomic status, age, and sex. Am J Public Health 103(5):881–888
Swedish National Institute of Public Health, Homosexuellas, bisexuellas och transpersoners hälsosituation: Återrapportering av regeringsuppdrag att undersöka och analysera hälsosituationen bland hbt-personer, S. folkhälsoinstitut, Editor 2005: Stockholm
The Public Health Authority of Sweden (2014) Utvecklingen av hälsan och hälsans bestämningsfaktorer bland homo- och bisexuella personer - Resultat från nationella folkhälsoenkäten Hälsa på lika villkor. Stockholm, Sweden
Gorman BK et al (2015) A new piece of the puzzle: sexual orientation, gender, and physical health status. Demography 52(4):1357–1382
Heck JE, Jacobson JS (2006) Asthma diagnosis among individuals in same-sex relationships. J Asthma 43(8):579–584
Landers SJ, Mimiaga MJ, Conron KJ (2011) Sexual orientation differences in asthma correlates in a population-based sample of adults. Am J Public Health 101(12):2238–2241
Meyer IH (2003) Prejudice as stress: conceptual and measurement problems. Am J Public Health 93(2):262–265
Cochran SD, Mays VM (2011) Sexual orientation and mortality among US men aged 17 to 59 years: results from the National Health and Nutrition Examination Survey III. Am J Public Health 101(6):1133–1138
Cochran SD, Mays VM (2012) Risk of breast cancer mortality among women cohabiting with same sex partners: findings from the National Health Interview Survey, 1997-2003. J Womens Health (Larchmt) 21(5):528–533
Hatzenbuehler ML et al (2014) Structural stigma and all-cause mortality in sexual minority populations. Soc Sci Med 103:33–41
Widgren K et al (2014) Delayed HIV diagnosis common in Sweden, 2003-2010. Scand J Infect Dis 46(12):862–867